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NPI Code Detail

MEDICARE: DEIDRA B HORTON LICSW

MEDICARE: DEIDRA B HORTON LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker110986MA

General Provider Information

NPI Number : 1659561496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEIDRA B HORTON LICSW
Provider Business Mailing Address
First Line : 172 LAFAYETTE ST
Second Line :
City : SALEM
State : MA
Zip : 01970-4815
Country : US
Telephone Number : 978-744-4033
Fax Number :
Provider Business Practice Location Address
First Line : 172 LAFAYETTE ST
Second Line :
City : SALEM
State : MA
Zip : 01970-4815
Country : US
Telephone Number : 978-744-4033
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2007
Last Update Date : 07/27/2007

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Directions to “ DEIDRA B HORTON LICSW” Practice Location

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